Sarcopenia in chronic viral hepatitis:From concept to clinical relevance

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma(HCC)is increasing,chronic hepatitis B(CHB)and chronic hepatitis C(CHC)remain the most relevant risk factors for advanced liver disease worldwide.In addition to liver damage,hepatitis B virus(HBV)and hepatitis C virus(HCV)infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia,lymphoproliferative disorders,renal disease,insulin resistance,type 2 diabetes,sicca syndrome,rheumatoid arthritislike polyarthritis,and autoantibody production.Recently,the list has grown to include sarcopenia.Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0%of patients with advanced liver disease.Nonetheless,among published studies,there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia.In particular,the interaction between sarcopenia,CHB and CHC has not been completely clarified in a real-world setting.Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV.Thus,in the present review,we provide an overview of the concept,prevalence,clinical relevance,and potential mechanisms of sarcopenia in patients with chronic viral hepatitis,with an emphasis on clinical outcomes,which have been associated with skeletal muscle loss in these patients.A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV,independent of the stage of the liver disease,will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B

BACKGROUND Although the prognostic relevance of sarcopenia has been increasingly recognised in the context of liver disease,there is a paucity of data evaluating body composition in patients with chronic hepatitis B(CHB).Beyond virus-related factors,nutritional and metabolic aspects can be associated with skeletal muscle abnormalities in these patients and should not be disregarded.AIM To evaluate the association between components of sarcopenia and demographic,clinical,lifestyle,nutritional,and biochemical variables in CHB patients.METHODS Dual-energy X-ray absorptiometry(DXA)was used to assess muscle mass by quantifying appendicular lean mass(ALM)adjusted for body mass index(ALMBMI).Muscle function was evaluated by hand grip strength(HGS)and the timed up and go test.Metabolic-associated fatty liver disease(MAFLD)was defined according to the criteria proposed by an international expert panel.A body shape index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level,respectively.RESULTS This cross-sectional study included 105 CHB outpatients followed at the tertiary care ambulatory centre(mean age,48.5±12.0 years;58.1%males;76.2%without cirrhosis;23.8%with compensated cirrhosis).The DXA-derived fat mass percentage was inversely correlated with the ALMBMI(r=-0.87)and HGS(r=-0.63).In the multivariable analysis,MAFLD,sedentarism and central obesity were positively and independently associated with low ALMBMI.MAFLD and central obesity were independently associated with low HGS.CONCLUSION MAFLD and central obesity were associated with low muscle mass and strength in patients with chronic hepatitis B,independent of the liver disease stage.